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Passing the Primary
FRCA SOE
A Practical Guide
Passing the Primary
FRCA SOE
A Practical Guide
Dr Claire M. Blandford
MBBS FRCA EDRA PGCertMedEd
Consultant Anaesthetist, Torbay and South Devon NHS Foundation Trust
University Printing House, Cambridge CB2 8BS, United Kingdom
Cambridge University Press is part of the University of Cambridge.
It furthers the University’s mission by disseminating knowledge in the pursuit of
education, learning and research at the highest international levels of excellence.
www.cambridge.org
Information on this title: www.cambridge.org/9781107545809
C Cambridge University Press 2016
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2016
Printed in the United Kingdom by Clays, St Ives plc
A catalogue record for this publication is available from the British Library
Library of Congress Cataloguing in Publication data
Names: Blandford, Claire M., 1982– , editor.
Title: Passing the primary FRCA SOE : a practical guide / edited by Claire M. Blandford.
Description: Cambridge, United Kingdom ; New York : Cambridge University Press, 2016. |
Includes bibliographical references and index.
Identifiers: LCCN 2015048882 | ISBN 9781107545809 (pbk. : alk. paper)
Subjects: | MESH: Anesthesiology | Examination Questions
Classification: LCC RD82.3 | NLM WO 218.2 | DDC 617.9/6076 – dc23 LC record available at
http://lccn.loc.gov/2015048882
ISBN 978-1-107-54580-9 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy
of URLs for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
..................................................................................................
Every effort has been made in preparing this book to provide accurate and up-to-date information which
is in accord with accepted standards and practice at the time of publication. Although case histories are
drawn from actual cases, every effort has been made to disguise the identities of the individuals involved.
Nevertheless, the authors, editors and publishers can make no warranties that the information contained
herein is totally free from error, not least because clinical standards are constantly changing through
research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or
consequential damages resulting from the use of material contained in this book. Readers are strongly
advised to pay careful attention to information provided by the manufacturer of any drugs or equipment
that they plan to use.
To my wonderful parents, for all their love and support
Contents
List of contributors page viii
Foreword by Dr John Carlisle ix
Preface xi
Acknowledgements xiii
Exam 4 123
Introduction 1 Dr Thomas Bradley
Dr Claire M. Blandford SOE 1 123
SOE 2 144
Exam 1 12
Dr Claire M. Blandford Question bank 163
SOE 1 12 Dr Claire M. Blandford, Dr Cathryn
SOE 2 29 Matthews, Dr Theresa Hinde, and
Dr Thomas Bradley
Exam 2 44
Questions on Physiology and
Dr Cathryn Matthews Biochemistry 163
SOE 1 44 Questions on Pharmacology 166
SOE 2 65 Questions on Clinical Topics 168
Exam 3 86 Questions on Physics, Clinical
Dr Theresa Hinde Measurement, Equipment and
SOE 1 86 Safety 172
SOE 2 106
Index 175
vii
Contributors
Dr Claire M. Blandford
Consultant Anaesthetist, Torbay and South Devon NHS Foundation Trust
Dr Cathryn Matthews
Consultant Anaesthetist, Royal Devon & Exeter NHS Foundation Trust
Dr Theresa Hinde
Anaesthetic Registrar, Peninsula Deanery
Dr Thomas Bradley
Anaesthetic Registrar, Peninsula Deanery
viii
Foreword
Like you, dear reader, I have never tasted the ambrosia that accompanies success at the Struc-
tured Oral Examination. How might I pass, should fate dictate that I must in order to pursue
my ambitions as an anaesthetist? Help is at hand.
My friends Claire, Cathryn, Theresa and Tom have written this book. They have given you
the knowledge, skill and wisdom that they have honed running their successful ‘SWIPED’
course – the South West Intensive Primary Examination Day. As you would expect, this
book teaches you through questions that will be familiar to anaesthetists who have taken
oral examinations over the past five decades, even if those discussions roamed more freely
than they do nowadays. The key to passing is structure: practise structuring your answers
and your brain will become more accustomed to succinctly delivering those facts that will
lead you through to examination triumph.
You will not only be in receipt of good practice material, you will also have handy tips
from how to maintain your composure to how to present a professional impression. The
exam may be structured, but every opportunity to boost your marks should be sought in the
goal to reach and hopefully exceed that threshold of success – the magical 37 marks.
When you practise the material in this book also practice structured, composed profes-
sionalism.
I wish you good luck: the more you practise with this book, the luckier you’ll get!
John
Dr John Carlisle, Consultant in Anaesthesia, Intensive Care and
Perioperative Medicine, Torbay Hospital, Devon
ix
Preface
The Fellowship of The Royal College of Anaesthetists (FRCA) examinations are impor-
tant professional milestones in your anaesthetic career. They are often considered daunting
prospects as it is recognised that substantial amounts of hard work, time, dedication and
preparation will be required for you to gain the knowledge, skills and understanding you
will need to demonstrate in the examinations.
Within the FRCA examinations the Structured Oral Examinations (SOEs) are often
viewed by candidates as the most intimidating. This is because it is probably the examination
style with which you are least familiar. As medical school examinations have changed over
the years, less and less now use oral/viva voce type examinations, so the primary FRCA SOEs
might very well be the first time you are facing this examination style and you might well feel
you are entering a bit of a ‘voyage into the unknown’, especially in how to prepare for this
examination.
This book has been aimed at providing you with a practical guide. It is very much targeted
at the SOE section of the primary FRCA but may equally provide some useful material for
candidates taking their final FRCA SOEs.
Over the next few pages I will present some background information on the primary
FRCA SOE examination structure and marking scheme before moving onto some exam strat-
egy ‘hints and tips’. These hints and tips are drawn from my personal experiences and are
also a distillation of experience/observation in my role as Course Director for our region’s
primary FRCA SOE preparation course (SWIPED – South West Intensive Primary Exami-
nation Day).
The question material that then follows through Chapters 1–4 is laid out as worked mock
exam questions and answers. The aim is to provide you with examples of how you might
actually phrase and develop your answers. This book is not intended as a reference textbook
to take you back and explain core principles de novo, but very much a practical guide – an
‘examiner in your pocket’ perhaps!
Each chapter is laid out as a complete practice exam (i.e. contains one each of SOE 1
and SOE 2). A total of four full exams, comprising 48 questions, are therefore presented. The
book also contains ‘notes’ (development of further knowledge points/clarifications) and ‘tips’
(suggestions of ways to phrase things/pitfalls to avoid) along the way.
At the rear of the book you will find the same questions are presented in a different format.
Instead of being laid out as full exams the questions are subdivided totally by section, e.g.
all Physiology questions together and are presented as a list of sequential questions without
the answer expansions. You can therefore choose to use the book in one of two ways, or dip
between the two layouts, either using the book as guided worked answers for you to self check
or for your ‘examiner’ to review your answers against or by using the rear of the book to target
specific sections or as a question bank of material to fuel SOE practice sessions.
I have had the pleasure of being assisted in preparing this book by three colleagues who
have each written individual chapters of exam material; Dr Cathryn Matthews (Chapter 2),
Dr Theresa Hinde (Chapter 3) and Dr Thomas Bradley (Chapter 4).
Considerable time has gone into preparing and developing these questions and I apolo-
gise now for any errors and omissions that remain; they are my responsibility. The question
xi
Preface
material in this book should be viewed as mock questions, they are not directly drawn from
the college’s question bank but have been developed by the chapter authors. They are, how-
ever, good examples of the type and range of material that might be expected to be covered
and will certainly provide a useful practice resource for you.
We all wish you all the very best for your examinations.
Dr Claire M. Blandford
Consultant Anaesthetist, Torbay and South Devon NHS Foundation Trust
SWIPED Course Director
xii
Acknowledgements
I would like to thank Dr John Carlisle, Dr Robert Rowland and Dr Mary Stocker for their
advice and assistance with some of the material within this book.
xiii
Introduction
Dr Claire M. Blandford
Exam advice
Managing you
Exams are stressful – accepted fact
Exams are stressful, both on the day itself and also in the preparation for them. Try, if possible,
to do your exams at a time when you don’t also have major life events ongoing. This might
not always be possible but it is a good idea to try and look ahead and judge whether now is
the right time for both you and your family for you to undertake these exams and if not then
try and highlight a time when you will be able to do this. Should you find that unexpected
events unfold during the run up to your exam then make sure you seek support and discuss
things with your educational supervisor and college tutor.
You’ve already done lots of exams before to get to this point in your career – ah but this exam is
different!
True – but the important thing to remember here is that you know how you learn. There is no
substitute for knowledge in this exam. However well you can ‘talk the talk’ if you don’t know
the basic facts you will not ultimately succeed. Don’t get spooked into deviating from a learn-
ing style that you know works for you. It is genuinely worth sitting down for a few minutes
and considering what learning styles suit you. Are you a list maker? Do you work better alone
or in groups? Do you like drawing spider diagrams to link your knowledge? You absolutely
must learn the required knowledge; core areas such as cardio and respiratory physiology will
cultivate little examiner sympathy if you do not know the material. Knowledge preparation
is one half of the story here.
Get talking!
For this exam in addition to having the core knowledge you will be required to demonstrate
your understanding and be able to put this across verbally to your examiners. This requires
practice, practice and more practice. And you will require other people for this. Depending
on which hospital you are working in at the time of your exam you may find there are several
other people also sitting the exam at the same time as you, or you might be the sole trainee
for that exam sitting. A proactive approach is needed. Try to link up with others and arrange
some SOE practice sessions, ask consultants and senior registrars in your hospitals to do
some exam practice with you; your deanery may have resources and can link you in with
trainees in other hospitals that are also doing the exam if you find you are the only one in
your hospital. There are also numerous exam preparation courses out there which you can
arrange to attend. You must get talking!
Passing the Primary FRCA SOE: A Practical Guide, ed. Claire M. Blandford. Published by
Cambridge University Press.
C Cambridge University Press 2016. 1
Stress vs performance
Introduction
The relationship between stress and performance is important and the stress vs performance
graph (sometimes called the Yerkes–Dodson graph) is often referred to in its discussion.
A certain amount of stress (arousal) is important as, at low levels of stress, performance is
often low too. As stress levels increase so an optimum point is reached where performance is
at its peak. The issue occurs when stress levels continue to rise and exceed the point of optimal
performance. At this point it is said the ‘stress zone’ has been entered and the effect of further
increasing arousal leads to a fall in performance. Anxiety leading onto panic or anger then
become classic features of behaviour. It is important on the day of your examination to have
enough stress to rise out of the inactive/laid back zone to be at your optimum, but to manage
things so that you don’t exceed this peak and slip down the right hand side of this curve
into the stress/anxiety/panic/anger zone. Thorough preparation will go a long way to helping
achieve this balance. It is also important (in advance of the day itself!) to consider how you
recognise and respond to stress yourself and what measures/steps you can put in place to
improve things.
Exam structure
The details presented below were correct at the time of writing. You should consult the RCOA
website regularly and seek information from your college tutor in the run up to your exam
to update yourself on any changes and the latest information. There are some very use-
ful ‘run through’ videos accessible on the college website that will give you a lot of useful
information.
Knowing what you are going to face and what is expected of you is important.
The SOEs form the second component of the primary FRCA examination. They are face-
to-face examinations held at the RCOA premises in London. In order to get to this stage of
the examinations you will already have passed the multiple choice question paper for the
2
Introduction
primary. The SOEs are taken on the same day as the Objective Structured Clinical Examina-
tions (OSCEs). You are required to take both components on your first attempt. Should you
pass one (e.g. OSCE) but fail the other (i.e. SOE) then you will be able to hold the pass in
the component in which you were successful for up to three years and return to the college
at another examination sitting to resit the other component. The SOEs, although examined
across two exams (SOE 1 and SOE 2), are passed or failed as a whole, i.e. you cannot carry
forward a pass in SOE 1 and just resit SOE 2 at a later date.
Format
Both SOEs are 30 minute examinations.
SOE 1: Pharmacology and Physiology
SOE 2: Clinical Topics and Physics, Clinical Measurement, Equipment, Safety
You will notice that each SOE is divided into two sections. Each of these sections are exam-
ined for 15 minutes and run consecutively to make a 30 minute SOE. Within each 15 minute
section there are three questions, each one being examined for 5 minutes. Therefore SOE 1
is actually composed of 6 × 5 minute questions; 3 to pharmacology, 3 relating to physiol-
ogy, as shown in the table below. The relevance of understanding this breakdown becomes
particularly clear when looking at how marks are awarded.
SOE components divided by section, question and time allocation
SOE Sections Questions
Question 1 (5 min)
Pharmacology (15 min) Question 2 (5 min)
SOE 1 Question 3 (5 min)
30 min Question 1 (5 min)
Physiology (15 min) Question 2 (5 min)
Question 3 (5 min)
Question 1 (5 min)
Clinical Topics (15 min) Question 2 (5 min)
SOE 2 Question 3 (5 min)
30 min Question 1 (5 min)
Physics, Clinical Measurement, Safety,
Question 2 (5 min)
Equipment (15 min)
Question 3 (5 min)
The Clinical section is also examined and marked as 3 × 5 minute questions although to
the candidate the distinctions between these sections may be less clear as it may be structured
more as an evolving discussion moving through pre-operative assessment and optimisation
of a case, into the specifics of anaesthetizing the case and then perhaps covering the manage-
ment of a critical incident.
The SOEs may be examined in either order, i.e. when you receive your examination
timetable for the day you will be given a separate time for SOE 1 and a separate time for
SOE 2. SOE 1 is not automatically the first of the SOEs that you will sit, SOE 2 might just as
equally be before it as after it.
3
On arrival
Introduction
There is a candidate briefing prior to each SOE. During this time the invigilator will tell you
which examination cubicle you will be examined in and there should also be time for a quick
drink of water, if you desire, prior to entering the examination room.
A separate note about the Clinical Topics section (SOE 2). This section of the examination
is preceded by 10 minutes of preparation time. You will be given a clinical scenario by the
invigilator conducting your candidate briefing. All candidates in your group will have the
same scenario. On the piece of paper you are given there will be brief details of a clinical
case. In addition to the description of the case there may be some supplementary data such
as blood results given. You will have 10 minutes, under exam conditions, to consider this case
in advance of entering the examination room and beginning the SOE. It is not necessary to
try and memorise the details of the case as an identical version will be provided for you in
the examination room for you to refer to.
Timing
The SOE exams are 30 minutes in duration. There will be a bell to commence the examination,
a further bell at 15 minutes to alert the examiners to change topics to the second section and
a final bell to end the examination. Your examiners will guide you through the timings and
will move questions when appropriate, you do not need to worry about this, they lead the
process.
Examiners
You will be examined individually by two examiners. You will have a different pair of exam-
iners for SOE 1 and SOE 2. Within each exam, one examiner will ask questions about the
first section whilst the second often takes notes. They will then swap roles for the second sec-
tion of the SOE where the other examiner will lead the questions. Regardless of whether the
examiner is leading the questions or listening/note taking they will both independently score
each of your answers.
The SOE exams are conducted in a large examination room that is subdivided into a series
of cubicles (often around 12), which are denoted by a letter of the alphabet. You will be given
the letter of your cubicle in the exam briefing by the invigilator. It is not permitted for you
to be examined (in the SOEs) by an examiner whom you know. If when you enter the exam
cubicle you know/recognise either of the examiners you must disclose this. The situation
is easily resolved and you will be taken to another exam cubicle within the same room and
placed with different examiners. This means there is often a pause before the SOEs commence
whilst it is confirmed that the placement of candidates within each cubicle is satisfactory. The
exam will not commence until this has all been confirmed. You will not be moved once the
exam is in progress.
Although you might not know the two examiners who you are placed with it is important
to be aware that you might be moved cubicles in order to facilitate accommodating another
candidate in an adjacent cubicle who does know their examiners. All marking sheets, etc., are
automatically transferred and safety measures are in place to confirm that the correct marks
are attributed to correct candidates if cubicles need to be changed.
There may be a third person seated in the cubicle when you enter. They will be an observer
4 (a college tutor or a potential future examiner perhaps) who is attending the exam for the day.
Introduction
They play no role in the conduct of your exam or the marking and you should try and forget
about their presence. When you are seated they are normally out of your line of sight.
Marking
Each 5 minute question is awarded marks by the examiners. Marking is done at the end of the
exam after you have left the examination cubicle. Examiners may confer to discuss aspects
of your performance or to clarify points you made but they will individually award marks.
Whether the examiner was leading or predominantly listening to your question they both
have an identical number of potential marks to be able to award you.
Each question is scored as follows (see the table below).
Mark descriptors
Score Descriptor
2 Pass
1 Borderline
0 Fail
Questions are scored individually rather than an ‘overall impression’ mark being awarded
to your whole exam. This is important to remember – you should try your very best on each
question but view each question during the exam as a clean slate, do not carry forward neg-
ative feelings or worries about a previous question as it may adversely affect the rest of your
performance (and hence marks), in the remaining questions for that exam.
Passing the exam is achieved by mark aggregation. If you achieve a mark of 37 or greater
across the two SOEs (SOE 1 + SOE 2) then you are awarded a pass. A pass is not conditional
on a precise distribution of these marks but on the arithmetic gain of a sufficient score. The
maximum potential score is 48 marks, as illustrated in the table below.
Maximum potential mark allocation for SOEs
Score per Examiner 1 Examiner 2 Total marks
question max marks max marks available
SOE 1 Pharmacology 3 × questions 0–2 6 6 12
Physiology 3 × questions 0–2 6 6 12
SOE2 Clinical 3 × questions 0–2 6 6 12
Physics and 3 × questions 0–2 6 6 12
Measurement
= 48 marks
Results
Results are posted online, listed by your candidate number and your college reference num-
ber. Your name is not used. The SOE will show as either ‘pass’ or ‘fail’. Precise scores are not
given. The results are normally available from 2 p.m. the next working day after your exam.
For Friday examinations the exam board will try, if possible, to display results from 8 p.m.
that evening. A letter will ultimately follow from the college which will provide confirmation
of the specific marks you gained in each section of the examination. You are allowed to ask
for feedback on your performance from the college. This request must be in writing, after you 5
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